Cases reported "Biliary Fistula"

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11/34. Hepatobiliary cystadenocarcinoma connected to the hepatic duct: a case report and review of the literature.

    We present a rare case of hepatobiliary cystadenocarcinoma with biliary communication. A 74-year-old woman had a liver cyst that had enlarged from 5 cm to 8 cm in diameter over the last 2 years. A mural nodule, 1 cm in diameter, was first demonstrated by computed tomography in a multilocular cyst in segment IV. The nodule showed hypervascularity at angiography and computed tomography during arteriography. Percutaneous transhepatic cystography demonstrated a communication between the cyst and the biliary tract. The cyst was filled with mucinous and gelatinous fluid and was revealed to contain cancer cells. The patient underwent total tumor extirpation with the surrounding hepatic parenchyma. We confirmed and closed the biliary fistula connected to the right hepatic duct. Histologically, the cyst wall was composed of cystadenoma and the mural nodule showed in situ papillary adenocarcinoma. The patient is doing well 9 months after surgery. Complete tumor extirpation and closing of the biliary fistula is the treatment of choice.
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12/34. Cholecystocolonic fistula: serial CT imaging features.

    We report the CT imaging findings of an unusual case of cholecystocolonic fistula, which had presented in the emergency department with melena. It is rare for the fistulous communication to occur between gallbladder and the colon. We describe the serial imaging findings, which were diagnostic of this condition.
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13/34. Parapapillary choledochoduodenal fistula associated with cholangiocarcinoma.

    Parapapillary choledochoduodenal fistula is a rare disorder. We herein report a case of parapapillary choledochoduodenal fistula associated with cholangiocarcinoma. A 61-year-old woman was admitted to our hospital for further examination of a liver tumor. She had no clinical symptoms, but computed tomography scans showed an irregularly contoured liver tumor which was histologically confirmed to be adenocarcinoma, by a needle biopsy examination. Duodenal fiberscopy revealed a fistula orifice 1.0 cm proximal to the orifice of the papilla of Vater, and endoscopic retrograde cholangiography through the fistula showed a communication to the common bile duct. Hypotonic duodenography demonstrated reflux of contrast material into the choledochoduodenal fistula. The bile sample collected from the common bile duct showed extremely high levels of pancreatic enzymes, including amylase, phospholipase-A2, and elastase-I. Furthermore, helicobacter dna was detected in bile by polymerase chain reaction (PCR) analysis. This experience suggests to us that parapapillary choledochoduodenal fistula may be a risk factor for biliary tract carcinoma, and surgical management is the treatment of choice for this rare condition, even when the patient has no significant clinical symptoms.
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14/34. Congenital bronchobiliary fistula: first case in an adult.

    The first adult case of a congenital communication between the biliary tract and the right main bronchus is reported. Treatment by surgical excision and pneumonectomy was successful.
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15/34. Pyelo-choledochal fistula accompanying operative cholangiography.

    Fistulous communications between the biliary system and the urinary tract are encountered infrequently and, routinely, they are associated with operative dissections involving both systems. We report a case of opacification of the right renal collecting system during cholangiography following uneventful cholecystectomy. Prompt spontaneous resolution was verified by subsequent excretory urography.
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16/34. Intrapancreatic communication of bile and pancreatic ducts secondary to pancreatic necrosis.

    An unusual complication of acute necrotizing pancreatitis occurred in which erosion of the intrapancreatic common bile duct and cephalic pancreatic duct formed a pancreaticobiliary cavity. This pancreatic process was observed to enhance during contrast computed tomography and was hypervascular during angiography, making preoperative diagnosis difficult. To our knowledge, the spontaneous development of such a cavity as a complication of acute pancreatitis has not been reported. The patient was successfully treated with pancreaticoduodenectomy.
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17/34. A case of pericholecystic abscess diagnosed by ultrasonography.

    Pericholecystic abscess is a serious complication of cholecystitis. Though preoperative diagnosis is easy by gray-scale ultrasonography, there has been no case reported in which the communication between pericholecystic abscess and the gallbladder was demonstrated ultrasonically. We experienced a case in which the communication route between a pericholecystic abscess and the gallbladder was successfully demonstrated by a real-time electric linear scanner. Furthermore, the abscess was successfully treated by percutaneous drainage following ultrasonically guided puncture. This success demonstrates that ultrasonography by a real-time scanner can be effective for diagnosis and treatment of acute cholecystitis and pericholecystic abscess.
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18/34. Endoscopic retrograde cholangiography (ERC) in surgical emergencies.

    Twelve patients, presenting with an acute abdomen of suspected biliary tract origin, had endoscopic retrograde cholangiography performed. Eight patients had either traumatic, spontaneous, or postoperative biliary tract fistulas with five leading to the peritoneal cavity, one to the colon, one to the bronchial tree, and one to the liver parenchyma from a ruptured gall-bladder. Each was confirmed by endoscopic retrograde cholangiography. Four patients with jaundice, following traumatic rupture of the liver, had a pathological communication between the intrahepatic biliary tracts and the hepatic vascular system. It is concluded that ERC is a reliable method for obtaining precise localization of biliary tract problems in surgical emergencies both pre- and post-operatively.
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19/34. rupture of a hydatid cyst of the liver into the biliary tract.

    rupture of a hydatid cyst into the biliary tract occurs in 5% to 10% of patients with hydatid disease of the liver. The communication between the hydatid cyst cavity and the biliary tree may produce intermittent or progressive obstructive jaundice. The presence of such jaundice complicates the diagnosis since it resembles other biliary disorders such as stone or infection. We treated six patients with hepatic hydatid cysts, four with minute fissures and two with wide ruptures into the biliary tract. The pathophysiologic mechanisms, diagnostic procedures and treatment are discussed.
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20/34. Cholecystoduodenocolic fistula with recurrent gallstone ileus.

    The combination of cholecystoduodenocolic fistula with gallstone ileus is rarely seen. To our knowledge, there have only been six previous reports with these findings. A 66-year-old woman's condition was diagnosed preoperatively as small-bowel obstruction and communications between the gallbladder, duodenum, and colon. The small-bowel obstruction was successfully relieved by removing a large gallstone from the midileum, leaving the inflammatory mass in the right upper quadrant undisturbed. Three weeks later the small-bowel obstruction recurred. At reoperation two gallstones were found obstructing the midileum and were removed. The cholecystoduodenocolic fistula was dissected and the duodenum and colon were repaired. A cholecystostomy was done. The patient recovered and has been well four years later.
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